Health Care Policy
Wednesday in my Committee on Health Care Policy we heard four bills, including my HB 608. HB 608 would establish a pilot program within MoHealthnet using the Health Stamp program I have previously written about. It would be similar to a Health Savings Acct. with built in incentives for recipients to manage their own healthcare. They would need to see a dr. at least once a year for preventative care. They would have a set amount depending on their current health status for the entire year. If they managed to have money left in their account at the end of the year they would be allowed to keep 25% towards the next year. This will encourage less frequent use of the Emergency Room for non-emergency visits and more use of a primary care provider among other cost saving practices. It will also increase provider reimbursement rates. This will encourage more providers to participate and provide better access to care for the participants. This is still in the discussion phase and is a work in progress.

SB 126 is an act that states Missouri licensed pharmacies cannot be required to carry or maintain an inventory of any specific drug or device. This passed out of committee with my HB 387 amended to it. HB 387 is the bill that changes the laws regarding the scope of practice for physician assistants. Currently a physician assistant (PA) must work with the supervising physician 66% of the time. My bill changes that to only require the PA and the Supervising Physician to work in the same facility at least four hours for every 14 days of patient care.

SB 178 makes some changes relating to mental health facilities and SB 302 allows pharmacists to dispense emergency medication without prior authorization from the prescriber. Both of these were passed out of committee.

Second Amendment
This week in Washington, D.C. the gun control lobby and President Obama were handed a defeat when a procedural motion was defeated when it failed to gain 60 votes in the Senate. I am not an insider in DC, but it appears to me that the momentum to infringe on our Second Amendment rights by the federal government hit a brick wall with the failure.

In the Missouri House we also took up the issue of the Second Amendment to the U S. Constitution full square. We took up a bill that I Co-Sponsored, HB 170, and another 2nd amendment bill HB 436 that assert the 10th amendment, which protects the rights of the states against encroachment by the federal government in areas where the state has sovereignty. There was much debate over the course of many hours on the House floor this week regarding the right of the state of Missouri to determine for itself what is a constitutional law and what is not. During floor debate I had a discussion with a member of the minority party who happens to also be an attorney. We had a very reasoned, calm and thoughtful discussion about the issues as he and his party saw them and how I and my party saw them. It comes down to the meaning of Article VI of the US Constitution in my opinion. Given below is Article VI:

U.S. Constitution Article VI
"All Debts contracted and Engagements entered into, before the Adoption of this Constitution, shall be as valid against the United States under this Constitution, as under the Confederation.

This Constitution, and the Laws of the United States which shall be made in Pursuance thereof; and all Treaties made, or which shall be made, under the Authority of the United States, shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby, any Thing in the Constitution or Laws of any State to the Contrary notwithstanding.

The Senators and Representatives before mentioned, and the Members of the several State Legislatures, and all executive and judicial Officers, both of the United States and of the several States, shall be bound by Oath or Affirmation, to support this Constitution; but no religious Test shall ever be required as a Qualification to any Office or public Trust under the United States."

In my opinion," the Laws in the United States which shall be made in the pursuance thereof "means that if a law is not made in the pursuance thereof, it shall not be the supreme Law of the Land. Who gets to decide whether a law is made in the pursuance of the Constitution? I contend that it is each state and not the collective body of states that have the right, and I would say the duty to declare laws that are not made in the pursuance of the Constitution, to be void. The states created the federal government and many writings of our Founding Fathers indicate that it was not their intent to create a federal government the powers of which were to supersede the rights of the states to determine which laws are Constitutional and which are not. The states did not give the federal government, through one of its branches, the Supreme Court, the authority to be the final arbiter of which laws are Constitutional and which are not. Rather the people through their elected state representatives retained the power to make that determination. Therefore when the federal government oversteps its bounds, it is the duty of the state government to call out the transgression of the federal government and assert the rights of the citizens of the state to be free of such tyranny.

In the opinion of my liberal barrister colleague, the federal government, through its Supreme Court, is the entity anointed with the power to issue the final and definitive opinion about whether a law is in the pursuance of the Constitution. Here lies the future of our state and our country. We cannot allow the federal government to determine that a law is constitutional when it is held by the people of our state, through their elected representatives not to be so. The relationship of the people to their elected representatives is closest with the State Representatives and State Senators as evidenced by the sheer number of constituents represented by a State Representative (37,199) vs. a member of the U.S. congress (634,500).

HB 350 Guns and Electronic Medical Records
I was able to place an amendment on HB 436 that included two sections. One prohibits the publication of a list of gun owners, and the second part prevents the requirement by law that a physician or other licensed health care professional from being required to inquire about, document or report the gun ownership status of a patient. When HB 436 was passed, my amendment was a part of it. Now if HB 436 is passed in the senate and signed by the governor, it will become law and protect our second amendment rights from our medical records being hijacked as a federal gun registry and it will keep me (as a physician) from acting as a federal agent feeding data into a federal gun registry. This amendment however, does not over-reach as some other bills currently working their way through the legislature do. Another Representative is carrying HB 732, which provides the following:

I believe that we must protect the doctor's ability to have a discussion about guns if he or she feels it is appropriate. If there is a troubled teenager within a family, there might come a time when the family doctor, sensing a worsening of the youngster's outlook on life, may suggest to the parents that now might be a good time to lock up any guns in the house or remove them from the house altogether. No one is hurt by that discussion and it could save a life. My bill prevents such info from landing in a database that could be misused, repurposed, or hacked.

HB 351 Hospital Regulatory Reform
This week on the house floor we took up HB 351, which streamlines the inspection and regulation of hospitals. We perfected and printed 351 on Wednesday (voted on it the first time) and today, Thursday, we third read and passed it (voted on it for the second time). The second time, third reading and passage is an up or down vote with no further opportunity to amend the bill. The vote today had only one 'no' vote out of 163 Reps, I was very happy with that vote of confidence so to speak.

Health insurance Committee
Today, after final adjournment of the House, the Committee on Health Insurance met in executive session. We discussed several health insurance related bills which were very complex. One of them dealt with a provision of ObamaCare. One of the things we discovered under the Pelosi doctrine (we have to pass bills to find out what is in them) is that a new profession has been created in the United States that did not formerly exist. The profession of "Navigator" has been created, and the money to pay the members of this new profession has already been printed by the federal government. About 50 million dollars has been allocated to this new profession, and the federal government will spend about 1.4 million dollars paying the salaries of these people. What is the job all about? Explaining, or attempting to explain, ObamaCare to people. Yes, Nancy, not only have we discovered that the affordable Care Act is not so affordable, but it is such a complex law that a whole new profession has been created to explain it to us. During these Committee discussions today, I learned that the average increase in insurance premiums in Missouri as ObamaCare rolls out into full implementation will be 58%! So much for lowering the average insurance premium by $2,500 per year, which was used as a selling point when the Affordable care Act was being sold to the Congress and the people. I recently heard from a constituent who told me he just received the new rate for his insurance premium and that it will be increased by $700 per month.

Now back to the Navigators. One of the provisions of the state statute that is being proposed is that if an individual already has health insurance, a navigator cannot provide information to them about other available coverage, but has to refer that individual back to the insurance agent who has the individual's policy. Another provision of the proposed legislation is to allow insurance companies to establish plans with narrow panels of providers without the option to go out of the network if you want insurance to pay for that service. While this limits a patient's choice, it reduces cost since the insurance company can bargain with the doctor (or hospital) to get the prices down if the doctor (or hospital) is going to get a volume of business from participation. If this sounds like medical care and medical practice is becoming a commodity- it is. There is much more to be done in this area and no vote was taken today on this topic. There is plenty of food for thought.

Visiting the Capitol
I always enjoy it when constituents visit the Capitol.
If you ever find yourself in or around Jefferson City at any time during the year, please feel free to visit us.